Provider Demographics
NPI:1710258744
Name:ESTEPA, MAMERTO AGCAOILI JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MAMERTO
Middle Name:AGCAOILI
Last Name:ESTEPA
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:1286 UNIVERSITY AVE # 545
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3312
Mailing Address - Country:US
Mailing Address - Phone:760-456-9086
Mailing Address - Fax:760-456-9086
Practice Address - Street 1:1452 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3405
Practice Address - Country:US
Practice Address - Phone:619-291-5433
Practice Address - Fax:919-209-3608
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADC32131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor